saribeth

never, never, never....these poor pts have been through enough already by the time they come to us. :grn: Good that you listened to your gut!!!!!

I know that the nurses that work for profit hospices are doing a wonderful job and doing it because they love what they do. In my little corner of the world our VNA is really losing so many referrals to the for profits with their heavy marketing and all of the extras they can provide. We can only offer what medicare gives us and we all know it never covers what we do. There is so much competition in our area that we are barely keeping afloat...we are small but we all put our whole selves in...just like the Hokey Pokey!!!!! :)

Very curious about medicare's criteria for "continuous care." I was under the impression that it had to be a "skilled nursing" activity every 15 minutes. Could anyone clarify or explain what exactly they require? thanks as always...

What about when a pt is actively dying???? Don't you visit daily???? At our VNA the visits are totally up to the nurse. For documenting frequency in the POC we put 1-5x weekly x13 + 3-4 for sx management.

I have "support meetings" every other month with the team. I play some calm music and we discuss difficult cases. Recently I have been doing some fun things...trivia questions, ice breaker type exercises, we even did a mini scavenger hunt...it is a nice escape from the craziness of the day to day "stuff".

Hi kids...just wondering if your hospice census is on the low side...our home care is low also... thanks:confused:

well get a load of what we do...our manager heard about this at a reginal meeting...plastic zip lock bags with kitty litter...dump the liquids, pills etc and patches (opened and folded in half) and buried deep in the trash with a prayer:saint: almost everyone has a zip lock type bag and if I don't have the litter with me I use paper towels to soak it up!!!!!!!

What about Failure to Thrive or Total Body System Failure???? I know Medicare doesn't love those but heck, it is what it is!!!!

I had investigated this a few years ago and the amount of petroleum in vaseline is very low compared to what it was years ago...so lather her up and make sure you have a fire extinguisher close by...just kidding:p

We have had really good results with Dexamethasone 4mg bid..it increases appetite and gives them a feeling of "well being" (oxymoron I know)! What about a fentanyl patch starting with 75-100 mcg and the percocet for BTP...maybe with the patch she will not feel as if she is taking so many oral meds???? All the best

Upon admission we have the pts doc sign the SO...they are already signed by our med director. For our comfort pack SO, even though they have signed off on the morphine etc, we do get a new order if the pt begins using the morphine on a regular basis! I truly believe most of the docs barely look at the SO, they just sign on the dotted line!

Hi kids...From what I can gather death can come rather abruptly with ALS and at times does not follow the "typical" s/sx of dying...Is that accurate? Any insight would be most appreciative...thanks so much!

This is how we write the orders: SN: 1-5x week and 3-4prn for sx management x13weeks MSW: 1-4xmo and 3-4 prn for distress Chaplain: same HHA: 2h 5x week x13 wks Volunteer: 1-5xmo and 3 prn hope that helps!

I do go to the funeral home if I am close to the pt and family (which usually happens) and I almost always write a note...I do it for me and I know the families appreciate it...professional boundries now that's a very interesting topic...NHPCO just had an audio conference about it...anyone listen to it?

We use lap tops...the program is Clinical Novius but it truly is geared toward home care...they told us from the very beginning that it would not save time and boy were they right!!!!!!! I have a love/hate relationship with mine because at times it holds you hostage... it was a real adjustment doing it in front of the pts but I always try to finish it in their home so I don't have to do it at the end of the day...its been 1.5 years and just when you think you've got it...ya don't!!!

We use the FLACC SCALE...We make copies for the families to have in the home so they can also do an assessment...just go on the web and type FLACC SCALE and pull up the Nat'l Hospice and Palliative Care Org site...I could not find it by just going into their web site! It's a fairly good tool!

Hi kids...our hospice is developing a team leader position...can anyone tell me what they do specifically? thanks and enjoy the final days of summer!

We have a check list...absence of Pulse, Respirations, B/P, pupils fixed and dilated...even when the pt is cold with the waxy color I still go through the VS and really really listen for that heart...sometimes pts have the agonal rhythm that stops eventually...it is quite a responsibility! all the best!:uhoh21:

hmmm I am a hospice nurse and I have a very deep faith, however...I only talk about the good Lord above IF a pt brings up the subject and I tread carefully. If I know they are Roman Catholic I would ask if they would like to have the annointing of the sick but our chaplain takes care of those issues...it sounded as if this nurse was seeking home care and hospice to "save" her pts...slippery slope

At our agency we have a check list...absence of P,R,B/P pupils fixed and dilated-all narcotics disposed of and witnessed by______(initialed) we notify the funeral home, MD, DME company, & HHA coordinator. We stay with the family until they remove the body... we also have to do the discharge in the computer and then the agency discharge...I miss those paper charts sometimes! God rest all of their weary souls:zzzzz You will be wonderful!

I agree...medicare should cover the cost but make sure they know she is a hospice pt and that she has a DNR:rolleyes:

Hi all, has anyone used Fentora for BTP with their pts? It's the transmucosal buccal fentanyl...does it work and is it expensive? Thanks

We do cover all meds that are directly related to the hospice dx...even ambien (which does not work for our older pts and it is costly) Our comfort packs are $28 and THE BEST THING but we don't order them for every pt. Sometimes good ol' morphine ($30 for 30mls) lorazepam, and scope patches are all we need. When a pt has PAAD (discounted program in NJ) we give the pharmacist the # and we pay the $5 copay! All in all with the medicare per diem rate it is hard to break even on a lot of pts!

I never realized that pt/family had to revoke to be compliant with medicare...when a pt is no longer appropriate for hospice care we have them sign the revocation form...if a pt had to go to the ER for a feeding tube that fell out we would have them revoke but now our CEO feels we should cover it. I don't know how medicare expects us to give our pts what they need with the current per diem rate...we rarely break even! I know that we do give out pts the very best care possible...just venting...sure is good having you guys around...I get so much valuable info always thanks!:loveya:

Hi all...I have a pt with Huntington's and he has developed these episodes of "coughing" that last for 3 hours plus and go into the wee hours...he does cough up small green mucous plugs (no fever) but minimal and then it is just clear sputum...one doc says Robitussin, the other says Claritin immediate dissolve tabs q 24h...I am thinking it is muscle spasms similar to the extremity movements...he is on 1.5mg of Haldol at bedtime...he responded fairly well with lorazepam 1mg..tossed around scopolamine patch?? Any ideas or insight into how we can prevent the episodes from beginning??????? thanks a bunch...(he has diminished breath sounds!)